title: Safety of ultrasound contrast agents in stress echocardiography.
abstract: Definity and Optison are perflutren-based ultrasound contrast agents used in echocardiography. United States Food and Drug Administration warnings regarding serious cardiopulmonary reactions and death after Definity administration highlighted the limited safety data in patients who undergo contrast stress echocardiography. From 1998 and 2007, 2,022 patients underwent dobutamine stress echocardiography and 2,764 underwent exercise stress echocardiography with contrast at the Cleveland Clinic. The echocardiographic database, patient records, and the Social Security Death Index were reviewed for the timing and cause of death, severe adverse events, arrhythmias, and symptoms. Complication rates for contrast dobutamine stress echocardiography and exercise stress echocardiography were compared with those in a control group of 5,012 patients matched for test year and type who did not receive contrast. Ninety-five percent of studies were performed in outpatients. There were no differences in the rates of severe adverse events (0.19% vs 0.17%, p = 0.7), death within 24 hours (0% vs 0.04%, p = 0.1), cardiac arrest (0.04% vs 0.04%, p = 0.96), and sustained ventricular tachycardia (0.2% vs 0.1%, p = 0.32) between patients receiving and not receiving intravenous contrast, respectively. In conclusion, severe adverse reactions to intravenous contrast agents during stress echocardiography are uncommon. Contrast use does not add to the baseline risk for severe adverse events in patients who undergo stress echocardiography.
authors.affiliation: Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ruvin S
authors.initials: RS
authors.lastname: Gabriel
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Smyth
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grimm
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Ellen Mayer
authors.initials: EM
authors.lastname: Sabik
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D004280:Dobutamine / Q000009:adverse effects*; D025401:Echocardiography, Stress; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000139:chemically induced*
chemical_list: D002316:Cardiotonic Agents; D003287:Contrast Media; D004280:Dobutamine